Gout is caused by high levels of uric acid in the blood that lead to painful inflammation in joints. It occurs when uric acid crystals deposit in joints, especially those in the big toe. Risk factors include diet high in purines, obesity, kidney disease, genetics, and certain medications. Symptoms range from joint pain and swelling to tophi formation and arthritis. Treatment focuses on lifestyle changes like diet modification and medication to reduce uric acid levels and relieve pain.

2. GOUT

3. Royal killer pain/ royal foot trap

4. DEFINITION
• Acute sudden inflammation of the joint
caused by high level of uric acid
concentration in the blood leading to the
development of tophi( Tophus)

5. High level of uric acid concentration in the
blood------Hyperuricemia
Normal Uric acid levels are 2.4-6.0 mg/dL
(female) and 3.4-7.0 mg/dL (male).
Blood uric acid level rises above 7 mg/dL.--
--Gout
Uric acid deposition called tophi ( Tophus)

6. Uric acid deposition called tophi ( Tophus)
Podagra--gout of the foot, especially the big toe.
Podagra ---‘foot trap’, is gout which affects the
joint located between the foot and the big toe,
known as the metatarsophalangeal joint

7. ETIOLOGY
Purine rich foods-
• Meat
– Kidney
– Liver
– Seafood
• Certain vegetables[peas, beans, cauliflower]
• Caffeine
Drugs [loop diuretics, Chemo, salicylates
corticosteroids]

8. • Trauma
• Infection
• Other disease [ DM, HTN, renal disease]
• Congenital/ hereditary

9. TYPES
Primary
Secondary

10. Primary gout
• In primary gout, a hereditary error of
purine metabolism leads to the
overproduction or retention of uric acid.

11. Secondary gout
• Secondary gout may be related to another
acquired disorder or may be the result of
drugs known to inhibit uric acid excretion.

12. Acquired disorder
Acidosis
Atherosclerosis
Diabetes mellitus
Hyperlipidemia
Hypertension
Obesity
Renal disease

13. Drugs
Chemo-
drugs
Salicylates Diuretics

14. PATHOPHYSIOLOGY

15. Abnormal metabolic process in the
body
Increase in uric acid in the blood ,
decrease in excretion of uric acid
Uric acid react with sodium in the
blood to form sodium crystals
Uric acid crystals Deposited in the
joints--Tophus

16. Activate inflammatory response, and release
of inflammatory mediators and free radicles
Free radicle damages the tissues
Release of proteolytic and Lysosome
enzymes
Leads to further Damages to the tissues
causing edema, redness and pain

18. Asymptomatic
• No symptoms
• Only by physical examination/
diagnostic studies
• Uric acid Level: 7-8 mg/dl

19. Acute stage
• Severe and sudden onset
• Only one or two joints will be involved
• Symptoms will appear usually at the night time
• Joints will be warm, red, oedematous, pain and
tender
• increase in uric acid level (8-12mg/dl)

20. Intermediate stage
• Symptoms will worsen over an extended time
• Joints will be warm, red, oedematous, pain and
tender
• Severe Pain
• Increased accumulation of uric acid crystals
• Uric acid level : 12-15mg/dl

21. Chronic
stage
• Continuous and persistent pain
• Decrease in the mobility of joints
• Increase in redness and edema
• Difficulty to treat with medicine
• Uric acid level: >15 mg/dl

22. COMPLICATIONS
Severe
degenerative
arthritis
Urate
Nephropathy
Renal failure
Renal calculi Fracture Infections

23. DIAGNOSTIC
• History and physical examination
• Family history of gout
• Blood test-
–Elevated serum uric acid levels
• Urine test-
–Elevated 24-hr urine for uric acid levels
• X-ray
–Presence of sodium urate crystals in
synovial fluid

25. Management
DRUG THERAPY
1. Non-steroidal anti-inflammatory drugs
–Ibuprofen –400mg
2. Corticosteroids
– (prednisone)—1-2mg/kg
3. Probenecid—500mg
–increases uric acid excretion in the urine

26. 4. Allopurinol ---300mg
is a purine analog
–decreases uric acid formation and may also
inhibit purine synthesis.
5. colchicine --500mcg
–interrupts urate crystal deposition in joint
tissues.

27. 6. Adrenocorticotropic hormone
(ACTH)
• ACTH helps to reduce the gout
inflammation
• Dose –40 IU

28. Foods to be avoided
Following foods should be avoided:
• Alcohol
• Red meat and organ meat such as liver or kidneys
• Seafood
• Certain vegetables[peas, beans, cauliflower]
• Caffeine
• Sugary drinks and foods high in fructose
• Processed foods and refined carbohydrates

29. NURSING MANAGEMENT:
GOUT
• Supportive care of the inflammed joints.
• Pain Management with NSAIDS
• Avoiding weight bearing exercises
• Limiting exercises during acute stages
• Dietary management to limit uric acid in blood
• Prevention of infection during steroid therapy
• Local heat application to the joint

30. Health education
• The nurse should explain
– gout is a chronic problem that can be controlled
with careful adherence to a treatment program.
– Thorough explanations regarding importance of
drug therapy and the need for periodic
determination of serum uric acid levels.
• -reducing/ eliminating the risk factors

31. • Aware of the dietary restriction
• Prevention of infections
• Assistance while moving
• Home management of pain with
analgesia and local heat applications

32. Thank you